In July 2023 New Zealand has seen 2,416,682 cases of COVID-19, 3,159 people have died, and a rolling average of 771 cases are reported each week. This is likely a significant underestimation of the prevalence of this disease.
Liu et al followed up all 3,096 cases of COVID-19 diagnosed in New South Wales in the first 5 months of 2020. They found that 80 per cent of people had recovered by 4 weeks, 90 per cent by 2 months and 93 per cent by 3 months after onset of symptoms.
It is estimated internationally that around 10 per cent of people who encounter the SARS-COV2 virus will have prolonged symptoms, or “long COVID.”
Based on the CODING done at practices across the Pinnacle network, only 0.5 per cent of cases subsequently are given a diagnosis of long covid. This probably represents a significant under coding of this illness.
However, these figures imply that between 4 and 77 new cases of long covid appear every week in NZ, and that between 240K and 12K people in NZ have long covid.
What do you expect to find when a patient has "long covid"?
Firstly CLASSIFY the illness - this is the only way we can track this disease.
Ongoing symptomatic COVID-19
Signs and symptoms of COVID‑19 from 4 weeks up to 12 weeks.
Snomed 191119303003 non-Snomed @2201.00.
Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
Snomed 1119304009.
Non-Snomed @2202.00.
The symptoms complex is very varied, SARS-COV2 impacts multiple organs, long-COVID has multiple manifestations, the commonest symptoms are fatigue, post-exertional malaise and cognitive dysfunction.
Davis et al. surveyed 3,762 post-COVID patients from 56 different countries and identified three different symptom clusters .
Cluster 1 have prolonged diarrhoea, loss of appetite, vomiting, runny nose, sore throat, dry cough, rattling breath, feeling feverish and elevated temperatures.
Symptoms have been present since onset and they tend to recover after 2- 3 months.
Cluster 2 have fainting, burning feelings, tachycardias, “COVID toe” rash, abdominal pain, nausea, bone and muscle aches, tight chest, confusion, ongoing taste and sense of smell changes, balance issues, hallucinations, headaches, insomnia, sleep apnoea, slurred speech, breathing difficulties with normal O2 saturations, productive cough, chills, flushing sweats, normal temperature, and fatigue.
These symptoms have often been present from week one of the illness and may persist for 6 months or more.
Cluster 3 have bradycardia, palpitations, bulging veins, peeling skin, petechiae, skin rashes, constipation, reflux, visual symptoms, hearing symptoms including tinnitus and hearing loss, the develop new allergies or new anaphylaxis, joint pain, muscle spasms, all the sensorimotor symptoms, “brain fog”, neuralgia, tremors, and vibrating sensations, menstrual and bladder problems, post exertional malaise and temperature control issues.
In this group the onset of symptoms may be 2- 3 months after the initial infection, and again may continue for months. (See figure 1.)
People in all groups find that stress, physical and mental activity can trigger relapses of symptoms, and one in three people who menstruate describe relapse during or before menstruation.
This is a growing area of research and the syndrome is still not fiully described.
In addition to “long COVID” you may come across “long-haul COVID” “post-acute COVID” “chronic COVID” and the “long term effects of COVID”.
Usefully the CDC categorise three types of post-COVID symptoms (*4).
New or ongoing symptoms described in the clusters above that may occur in anyone who has had covid19, including potentially those who were asymptomatic.
Multi-organ impacts, including the rare multisystem inflammatory syndrome which is more likely in children, that follow on from severe COVID-19 disease and may be associated with immune function dysregulation.
The physical and psychological impacts of hospitalisation and post-intensive care syndrome, which can leave people fatigued, suffering from post traumatic stress disorder, and with cognitive impairments.
Theories about the causes of new and ongoing symptoms include the triggering of an autoimmune phenomenon by the virus, and the reactivation of other underlying viral and inflammatory conditions made possible as the immune system preferentially responds to the SARS-Cov2 virus.
Studies into the symptom complex and pathophysiology are being actively pursued internationally , but the similarities with chronic fatigue syndrome have not been overlooked . It may be that the research into “long-COVID” will finally reveal what underlies other conditions that have been medically unexplained.
Given the breadth of potential symptoms long-COVID often requires a multidisciplinary approach with the support of many specialised services. The NHS is investing heavily in “long-COVID clinics” for children, adults and in general practice providing physiotherapists, occupational therapists, nurses, dieticians, social workers and doctors to work together to support families suffering from this condition (*7).
No such investment has been made in New Zealand, patients are expected to be referred to the necessary allied health teams and specialist services available in their district.
There are even a few New Zealand specific self-help groups developing online. The New Zealand COVID Long Haulers Facebook group has 244 members and Dr Anna Brooks leads @LongCovidNZ on Twitter, for those patients who Tweet.
Nalbandian et al reporting in Nature describe in detail the therapeutic approaches to the multiorgan syndromes characterised by long-COVID which may need specialised investigation, and medication management from cardiac, respiratory, endocrine, renal, dermatological, gastroenterological and psychiatric experts.
Patients with “long-COVID” need our help and support, they need our understanding and to be heard, and they need our skilled navigation of the multiple providers who need to be involved in their care.
During the COVID-19 lockdown virtual consultations for POAC cases were funded. We are pleased to announce that this will be a permanent change.
Read moreTe Whatu Ora Waikato has noted the wording in their recent newsletter about the new BPAC disease notification eReferral, requires clarification. At this time COVID-19 remains a notifiable disease, but that notification does not need to come via GP practices using the BPAC form as it is generated via result uploading.
Read moreThis funding is available for a GP/NP consultation with patients eligible for an advance prescription for COVID-19 anti-viral medication, prior to them testing positive for COVID-19. There is no obligation for a clinician to issue an advance prescription.
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